Health Care for the Homeless a unique challenge for nurses

Holle Garvey, a nurse practitioner with Mercy Medical Center s Health Care for the Homeless program, takes the blood pressure of a patient at the Worthington Street Shelter in Springfield recently.By Lori Szepelak
Correspondent
SPRINGFIELD " As the day was slowly starting for many at the Worthington Street Shelter on a recent Saturday morning, Holle Garvey and Anna Rivera had patients lined up to see them in the tight clinic quarters on campus.
I love the challenge of this setting, Garvey, a nurse practitioner with Mercy Medical Center s Health Care for the Homeless (HCH) program, said.
Garvey, her desk filled with hand sanitizers, respirator masks, Kleenex and gloves, works from a laptop computer as she asks basic health questions of each patient who comes through their door. Garvey noted that for some individuals who frequent the shelter, the clinic assures a continuity of care for them.
On the morning of May 2, men and women, some with weighted-down backpacks, praised the HCH nurses for these services.
These guys are great to us, one woman said as she had her hands and wrists examined by Garvey. Later in the morning, one gentleman commented that the nurses are always in a good mood.
Mercy s HCH program began in 1983 in a Springfield soup kitchen, operated by the Sisters of Providence of Holyoke. Arriving with basic medical supplies in the back of her station wagon, Sister Julie Crane, S.P., who was also a nurse practitioner, began ministering to the homeless people who frequented the soup kitchen. Crane treated abrasions, wounds and unattended coughs which were evidence of the lack of basic health care among this population. Seeing the health care needs of the homeless firsthand, Crane quickly was called to action and extended her ministry to the streets, shelters and even local bars.
Over the years, the program has grown with the financial support of the Sisters of Providence Health System (SPHS), of which Mercy Medical Center is a part, and with the recruitment of dedicated volunteers. When the McKinney Homeless Assistance Act was passed in 1987, HCH, along with the Springfield Public Health Department and Open Pantry Services, applied and received one of the first grants through the McKinney program which enabled the expansion of services to other sites.
Now in its 26th year, the clinical team provides primary care services on-site at 46 shelters, soup kitchens, job placement sites and transitional programs throughout Hampden, Hampshire and Franklin counties.
Twenty percent of the population we serve are homeless children and more than half of those children are under the age of five, Doreen Fadus, executive director, Mercy s HCH program, said. Fadus added that in 2008, her HCH team logged 12,000 encounters among local men, women and children.
Throughout the course of the morning at the Worthington Street Shelter, men and women took their turns receiving blood sugar and TB tests, medication management assistance and checks on flu-like symptoms.
As Garvey continued her assessments, case manager Anna Rivera was at her side, providing translation assistance when it was needed, as well as meeting the requests of those who sought out basic supplies including hair brushes, toothpaste and lozenges for their coughs.
You feel like an angel, Rivera said, noting she enjoys being a part of the HCH team. This is the best team to work with.
Fadus explained that the clinicians care for homeless people who can be very sick.
If their health issues are not addressed, minor health issues can grow into chronic, very costly health issues, she said.
Fadus added that homeless people have higher rates of being admitted to a hospital from an emergency room visit, and if admitted, tend to stay longer due to compromised health. The HCH clinicians not only treat symptoms but also address many underlying issues that homeless people may have including housing and health insurance problems.
The HCH clinical team includes six nurses, four nurse practitioners, one mental health clinician, one part-time advance practical nurse, one part-time physician and one part-time psychiatrist.
First and foremost, it is the right thing to do, Fadus said. Everyone should have access to health care, regardless of their means. Secondly, it is a cost-savings mechanism. Addressing health care issues in the initial stages and also promoting preventative care prevents exorbitant costs in the future. Third, many of our patients would not have access to primary and specialty care without our intervention, due to both availability and the reluctance of providers to work with the homeless.
As the HCH clinical team traverses streets, river fronts and local shelters across the valley, their best practice of helping others is put into action everyday.
Our clinicians don t look at their job as just health care but also take a very broad view of what they can do to help others, Fadus said.
Both Garvey and Rivera added that donations of socks, underwear and toiletries for men, women and children are always welcomed and greatly appreciated at any of the sites.
For more information on Mercy s HCH program, call 748-9064.